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INTRODUCTION: The aim of this study was to evaluate and analyze the first 29 cases of sleeve gastrectomy in Abidjan. PATIENTS AND METHODS: We analyzed the records of patients operated for morbid obesity in 3 private clinics in Abidjan by the team of Professor Alexandre N'Guessan from 2009 to 2014. This study included all patients who underwent laparoscopic sleeve gastrectomy for morbid obesity. RESULTS: A total of 29 patients were operated; 28 women and 1 man with a mean age of 34 years. Their body mass index (BMI) ranged between 35 and 49 kg/m2 with comorbidities. The laparoscopic procedure was possible in all cases without conversion. The average operative time was 3 hours. Patients were exeat in 70% of cases in the second postoperative day after methylene blue checks were conducted. Only 4 complications (1 phrenic abscess, 1 small bowel obstruction, 1 gastric stenosis and 1 digestive fistula) required surgical recovery. The operative mortality was 6.89%. Around 92.85% of patients had a loss of excess weight greater than 50% over 4 years, with an improvement of comorbidities. CONCLUSION: The sleeve gastrectomy is a feasible technique with our current working conditions. It requires a good patient selection, and a multidisciplinary team.

INTRODUCTION: Le but de ce travail a été d'évaluer et d'analyser les 29 premiers cas de sleeve gastrectomie à Abidjan. PATIENTS ET MÉTHODES: Nous avons évalué le dossier des patients opérés pour obésité morbide dans 03 cliniques privées d'Abidjan par l'équipe du Pr N'Guessan Alexandre de 2009 à 2014. Ont été inclus tous les patients ayant bénéficié d'une sleeve gastrectomie laparoscopique pour obésité morbide. RÉSULTATS: 29 patients ont été opérés; 28 femmes et 1 homme avec un âge moyen de 34 ans. L'indice de masse corporelle (BMI) compris entre 35 et 49 Kg/m2 avec des comorbidités. La procédure laparoscopique a été possible dans tous les cas sans conversion. La durée opératoire moyenne était de 3h. Les patients étaient exéat dans 70% des cas au 2ème jour post opératoire après un contrôle au bleu de méthylène. Quatre (4) complications (1 abcès sous phrénique, 1 occlusion du grêle, 1 sténose gastrique et 1 fistule digestive) ont nécessité une reprise opératoire. La mortalité opératoire était de 6.89%. environ 92,85% des patients avaient une perte d'excès de poids supérieure à 50% sur 4 ans, avec une amélioration des comorbidités. CONCLUSION: La sleeve gastrectomie est une technique réalisable dans nos conditions de travail. Elle nécessite une bonne sélection des patients, une équipe multidisciplinaire.

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Introduction : Le but de ce travail a été d'évaluer et d'analyser les 29 premiers cas de sleeve gastrectomie à Abidjan. Patients et Méthodes : Nous avons évalué le dossier des patients opérés pour obésité morbide dans 03 cliniques privées d'Abidjan par l'équipe du Pr N'Guessan Alexandre de 2009 à 2014. Ont été inclus tous les patients ayant bénéficié d'une sleeve gastrectomie laparoscopique pour obésité morbide. Résultats : 29 patients ont été opérés ; 28 femmes et 1 homme avec un âge moyen de 34 ans. L'indice de masse corporelle (BMI) compris entre 35 et 49 Kg/m2 avec des comorbidités. La procédure laparoscopique a été possible dans tous les cas sans conversion. La durée opératoire moyenne était de 3h. Les patients étaient exéat dans 70% des cas au 2ème jour post opératoire après un contrôle au bleu de méthylène. Quatre (4) complications (1 abcès sous phrénique, 1 occlusion du grêle, 1 sténose gastrique et 1 fistule digestive) ont nécessité une reprise opératoire. La mortalité opératoire était de 6.89%. environ 92,85% des patients avaient une perte d'excès de poids supérieure à 50% sur 4 ans, avec une amélioration des comorbidités. Conclusion : La sleeve gastrectomie est une technique réalisable dans nos conditions de travail. Elle nécessite une bonne sélection des patients, une équipe multidisciplinaire

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Laparoscopic surgery is now a widely accepted modality for gastrointestinal surgery. In this report the authors evaluate their four-year experience with laparoscopic surgery in a total of 494 patients in Abidjan, Ivory Coast. Cholecystectomy and appendectomy were the main indications in this series. However laparoscopic surgery has a wide range of applications in Black Africa not only for elective indications such as evaluation of chronic abdominal pain and digestive cancer but also emergency indications such as peritonitis and abdominal trauma.

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The purpose of this report is to describe two cases involving a 43-year-old man and a 41-year-old woman who underwent laparoscopic surgery for dolichocolon causing severe constipation. In both cases the procedure consisted of left colectomy with colorectal anastomosis. There was no operative mortality or morbidity. The outcome on constipation was good. This study demonstrates the utility of laparoscopy for treatment of dolichocolon in carefully selected patents.

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Objective : The aim of this study was to analyse the coelioscopic surgery in appenditis. Method : We done a retrocpective study concerning 150 coelioscopic surgery in appenditis during 42 months. Result : In the study period we done more than three times coelioscopic sergery. In our study we includ 86 femals (57,3%) and 64 males (42,7%). The mean reason of surgery was tipical clinical appenditis in 124 cases (82,6%), chronic abdominal ack in 10 cases and other reasons for the last 16 cases. The appendice was take of by the "external method" in 76 cases (50,6%) "internal method" in 9 cases (6%) and the two methods in 61 cases (40,6%). In 33 cases (21,3%) the surgery of appendice was associeted with other surgery. In term of morbidity we notice three cases of parietal abces (2%). Any mortality was notice in our serial. Conclusion : Ceolioscopic sergery is a good and pratical method in appenditis tratment it allows the minimizing of hospitalisation stay.

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The authors report the first case of Crohn's disease in Côte-d'Ivoire. A 20-year-old Ivorian man presented chronic diarrhea and weight loss over six years. Ulcerated lesions were found throughout the colon extending to the terminal ilieum but not involving the rectum. Diagnosis of Crohn's disease was established on radiological and histological findings. Treatment consisted of total colectomy with ileorectal anastomosis. This case is of special interest because of the extremely low incidence of Crohn's disease in black Africa.

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The authors report on a case of Darier-Ferrand's dermatofibroma on forehead. It was a very uncommon localization. They stress on the specific treatment applied: forehead cranioectomy and scalp plasty, made compulsory after several exercises and their reappearances.

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A retrospective study of 16 cases of ileo sigmoid knot, treated at Treichville Hospital in Abidjan Côte-d'Ivoire, is reported by the authors between 1970 and 1989. This pathology is not so seldom and concerned 14 men and 2 women from 14 years old to 61 years old with an average of 42 years. The more precise description of the physiopathology of this occlusion allows to classify this pathology as an independent entity from the other types of volvulus. The physiopathologic knowledge described allow a more precise diagnostic approach and a better codified therapeutic attitude.

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Buruli's ulcer is a real disease of public health. In Ivory Coast, 50 patients were treated from February 1987 to August 1991. It realizes a real destruction of skin and subcutaneous tissues. The germ is Mycobacterium ulcerans. The preferential localisation is the limbs in children of 14 years old. Large ulcer with polycyclic margin are treated by extended excision and thin skin grafts. But deformities persist after the surgical treatment. Hospitalisation is long and drugs are expensive.

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In one case of Dupuytren's contracture the authors make an important literature review. The affection is rare with the black man but frequent in caucasian population. Its origin is therefore european. They point out alcoholism and microtrauma due to the patient's antecedents and job.

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Pheochromocytoma exists in black African countries with the same frequency observed in other places. The characteristics of our series of nine patients are the followings: an average age of 19, 6 years old, a sex-ratio of 1, 25, a paroxysmal high blood pressure for six patients, no MEN neither malignant tumors, the measures of V.M.A. done positively eight times, a retropneumoperitoneum scan, seven arteriographies, three echographies which were consistently positive, one death post surgery by collapsus consecutive to tumor excision, only one contralateral recurrence and positive followings in all other cases.

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The physiopathology of combined volvulus of sigmoid and small intestine is discussed. In many cases a half-knot is involved, that is to say a "key" between the two ileal and sigmoid loops, difficult to describe with words but easy to understand by the use of a diagram and radiologic and intraoperative images of lesions, of possible assistance when releasing the loops or determining site of section of foot of occluded loops. Of 116 cases of sigmoid volvulus treated in the Treihville hospital, Abidjan between 1972 and 1983, eleven were associated with small intestine volvulus. Of these 11 cases, 9 were treated by emergency ideal colectomy and small intestine resection, with 3 deaths, and 2 by emergency ideal colectomy and small intestine reintegration, with 2 deaths. Operative mortality was therefore high (45%), global mortality being 24%. This is inherent in underdeveloped surgical units and will certainly improve greatly as hospital standing improves.

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Portal hypertension due to hepato-splenic bilharziasis is common in Abidjan, where we operated on 34 cases in 15 years. The indications for surgical intervention include gastrointestinal haemorrhage due to rupture of esophageal varices, a very bulky enlarged spleen and, more, rarely, recurrent ascites. Simple splenectomy (9 cases) suppresses discomfort and pain, corrects the hypersplenism and brings about a moderate reduction of portal pressure. Spleno-renal anastomosis (19 cases) remains the operation of choice. The long-term results, difficult as these are to assess under ill-regulated African conditions, appear satisfactory on the whole, due to less serious damage to the hepatocyte than in the cirrhoses (62% Child A and 29% Child B). We therefore continue to advocate splenectomy followed if possible by a spleno-renal shunt in bilharzial portal hypertension.

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This study is the authors' account of their experience of oesophagoplasty with the colon carried out among children in an african population. From 1978 to 1982, they performed 10 substernal intrathoracic transplantation of the colon to replace accidentally strictured oesophagus. The stricture in all cases is one to swallowing of corrosive substance, basic products (potassium lye and locally made bases) in half of the cases and battery acid in the other half. Follow-up has been between 9 months and 5 years. The results are as follows: In the immediate postoperative period there were: -- 1 death after surgery due to anesthetic error, -- 6 complications : -- 4 upper (cervical) anastomotic leakage, -- 1 incomplete stricture of the cervical anastomosis, -- 1 temporary dumping syndrome, -- 1 purulent pleurisy and parietal abscess; -- 3 cases without any complications. Before discharging the patients from the hospital, the functional results were evaluated on clinical features (quality of the deglutition, weight increase) and radiographically by a barium swallow (permeability of the colon transplant); these results were satisfactory. Long term follow-up was possible in 4 children (one monthly for the first 6 months, then once every 3 months for 6 months). Follow-up was less regular for the remaining 5 children. Except for a case of recurrent stricture of the cervical anastomosis which required reoperative surgery, normal deglutition was restored in all the patients, as was confirmed by a barium meal and a satisfactory weight gain.

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